Omicron exposes inflexibility of Europe’s public hospitals

Omicron exposes inflexibility of Europe’s public hospitals
Medical staff members care for a COVID-19 patient in the intensive care unit at the Strasbourg University Hospital, eastern France, Thursday Jan. 13, 2022. (AP)
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Updated 16 January 2022

Omicron exposes inflexibility of Europe’s public hospitals

Omicron exposes inflexibility of Europe’s public hospitals
  • That includes doctors, nurses and technicians at public hospitals

STRASBOURG, France: A World Health Organization official warned last week of a “closing window of opportunity” for European countries to prevent their health care systems from being overwhelmed as the omicron variant produces near-vertical growth in coronavirus infections.
In France, Britain and Spain, nations with comparatively strong national health programs, that window may already be closed.
The director of an intensive care unit at a hospital in Strasbourg is turning patients away. A surgeon at a London hospital describes a critical delay in a man’s cancer diagnosis. Spain is seeing its determination to prevent a system collapse tested as omicron keeps medical personnel off work.
“There are a lot of patients we can’t admit, and it’s the non-COVID patients who are the collateral victims of all this,” said Dr. Julie Helms, who runs the ICU at Strasbourg University Hospital in far eastern France.
Two years into the pandemic, with the exceptionally contagious omicron impacting public services of various kinds, the variant’s effect on medical facilities has many reevaluating the resilience of public health systems that are considered essential to providing equal care.
The problem, experts say, is that few health systems built up enough flexibility to handle a crisis like the coronavirus before it emerged, while repeated infection spikes have kept the rest too preoccupied to implement changes during the long emergency.
Hospital admissions per capita right now are as high in France, Italy and Spain as they were last spring, when the three countries had lockdowns or other restrictive measures in place. England’s hospitalization rate of people with COVID-19 for the week ending Jan. 9 was slightly higher than it was in early February 2021, before most residents were vaccinated.
This time, there are no lockdowns. The Institute for Health Metrics and Evaluation, a population health research organization based at the University of Washington, predicts that more than half of the people in WHO Europe’s 53-country region will be infected with omicron within two months.
That includes doctors, nurses and technicians at public hospitals.
About 15 percent of the Strasbourg hospital system’s staff of 13,000 was out this week. In some hospitals, the employee absentee rate is 20 percent. Schedules are made and reset to plug gaps; patients whose needs aren’t critical must wait.
The French public hospital’s 26 ICU beds are almost all occupied by unvaccinated patients, people ”who refuse care, who refuse the medicine or who demand medicines that have no effectiveness,” Helms said.
She denied 12 requests for admission Tuesday, and 10 on Wednesday night.
“When you have three patients for a single bed, we try to take the one who has the best odds of benefiting from it,” Helms said.
In Britain, like France, omicron is causing cracks in the health system even though the variant appears to cause milder illness than its predecessors. The British government this month assigned military personnel, including medics, to fill in at London hospitals, adding to the ranks of service members already helping administer vaccines and operate ambulances.
At the Royal Free Hospital in London, Dr. Leye Ajayi described a patient who faced delays in his initial cancer diagnosis.
“Unfortunately, when we eventually got round to seeing the patient, his cancer had already spread,” Ajayi told Sky News. “So we’re now dealing with a young patient in his mid-50s who, perhaps if we’d seen him a year ago, could have offered curative surgery. We’re now dealing with palliative care.”
Nearly 13,000 patients in England were forced to wait on stretchers more than 12 hours before a hospital bed opened, according to figures released last week from the National Health Service.
Britain has a backlog of around 5.9 million people awaiting cancer screenings, scheduled surgeries and other planned care. Some experts estimate that figure could double in the next three years.
“We need to focus on why performance has continued to fall and struggle for years and build the solutions to drive improvement in both the short and long term,” said Dr. Tim Cooksley, president of the Society for Acute Medicine.
Having the capacity to accommodate a surge is crucial, and it’s just this surge capacity that many in Europe were surprised to learn their countries lacked. The people in a position to turn that around were the same ones dealing with the crisis daily.
In the midst of the first wave, in April 2020, WHO’s Europe office put out a how-to guide for health systems to build slack into their systems for new outbreaks, including identifying a temporary health workforce.
“Despite the fact that countries thought they were prepared for a pandemic that might come along, they were not. So it’s building the ship as it sails,” said Dr. David Heymann, who previously led the World Health Organization’s infectious diseases department.
But France had been cutting back hospital beds — and doctors and nurses — for years before the pandemic. Building it back up in a matter of months proved too much when the current wave infected hospital staff by the hundreds each day. Even allowing symptomatic COVID-19-positive health workers to report for work hasn’t been enough.
Britain’s NHS Confederation, a membership organization for sponsors and providers, says the public health service went into the pandemic with a shortage of 100,000 health workers that has only worsened.
The first wave of the pandemic pushed Spain’s health system to its limit. Hospitals improvised ways to treat more patients by setting up ICUs in operating rooms, gymnasiums and libraries. The public witnessed, appalled, retirees dying in nursing homes without ever being taken to state hospitals that were already well over capacity.
After that, the Spanish government vowed not to let such a collapse happen again. Working with regional health departments, it designed what officials call “elasticity plans” to deal with sudden variations in service demands, especially in ICUs.
The idea is that hospitals have the equipment and, in theory, the personnel, to increase capacity depending on the need. But critics of government health policy say they’ve warned for years of inadequate hospital staffing, a key driver of the difficulty delivering care in the current wave.
“The key thing is flexibility, having flexible buildings that can expand, having staff that are flexible in terms of accepting task shifting, having flexibility in terms of sharing loads more of a regional structure,” said Dr. Martin McKee, a public health professor at the London School of Hygiene and Tropical Medicine.
Ultimately, though, McLee said: “A bed is an item of furniture. What counts is the staff around it,” McKee said.
Helms, the Strasbourg intensive care doctor, knows that all too well. Her unit has space for 30 beds. But it has only enough staff to care for the patients in the 26 beds currently occupied, a situation unlikely to change quickly after omicron burns through the region.
In the same hospital’s infectious diseases unit, frantic schedulers are borrowing staff from elsewhere in the facility, even if it means non-COVID-19 patients get less care.
“We’re still in the middle of a complex epidemic that is changing every day. It’s hard to imagine what we need to build for the future for other epidemics, but we’re going to have to reflect on the system of how we organize care,” said Dr. Nicolas Lefebvre, who runs the infectious diseases unit at the Strasbourg hospital.
He said Europe is prepared to handle isolated outbreaks as it has in the past, but the pandemic has exposed weakened foundations across entire health systems, even those considered among the world’s best.
Frédéric Valletoux, the head of the French Hospital Federation, said policymakers at the national level are acutely aware of the problem now. For 2022, the federation has requested more resources from nursing staff on up.
“The difficulty in our system is to shake things up, especially when we’re in the heart of the crisis,” Valletoux said.


UK confirms local transmission of monkeypox

UK confirms local transmission of monkeypox
Updated 58 min 2 sec ago

UK confirms local transmission of monkeypox

UK confirms local transmission of monkeypox
  • UK government had already started buying up stocks of smallpox vaccine

LONDON: Britain is seeing daily infections of the rare monkeypox virus that are unconnected to any travel to West Africa, where the disease is endemic, a health official said on Sunday.
The UK Health Security Agency (UKHSA) said new figures would be released on Monday, after it registered 20 cases on Friday.
Asked if community transmission was now the norm in Britain, UKHSA chief medical adviser Susan Hopkins said “absolutely.”
“We are finding cases that have no identified contact with an individual from West Africa, which is what we’ve seen previously in this country,” she told BBC television.
“We are detecting more cases on a daily basis.”
Hopkins declined to confirm reports that one individual was in intensive care, but said the outbreak was concentrated in urban areas, among gay or bisexual men.
“The risk of the general population remains extremely low at the moment, and I think people need to be alert to it,” she said, adding that for most adults, symptoms would be “relatively mild.”
The first UK case was announced on May 7, in a patient who had recently traveled to Nigeria. The disease is also spreading in Europe and North America.
Monkeypox can be transmitted through contact with skin lesions and droplets of a contaminated person, as well as shared items such as bedding and towels.
Symptoms include fever, muscle aches, swollen lymph nodes, chills, exhaustion and a chickenpox-like rash on the hands and face. They usually clear up after two to four weeks.
There is no specific treatment but vaccination against smallpox has been found to be about 85 percent effective in preventing monkeypox.
Education Secretary Nadhim Zahawi said the UK government had already started buying up stocks of smallpox vaccine.
“We’re taking it very, very seriously,” he told the BBC.


Bangladesh floods recede but millions still marooned

Bangladesh floods recede but millions still marooned
Updated 22 May 2022

Bangladesh floods recede but millions still marooned

Bangladesh floods recede but millions still marooned
  • Floods are a regular menace to millions of people in low-lying Bangladesh and neighboring northeast India

SUNAMGANJ, Bangladesh: North-east Bangladesh’s worst floods in nearly 20 years began receding on Sunday, but rescue workers were struggling to help millions marooned by extreme weather across the region that has killed around 60 people.
Floods are a regular menace to millions of people in low-lying Bangladesh and neighboring northeast India, but many experts say that climate change is increasing the frequency, ferocity and unpredictability.
In the past week after heavy rains in India, floodwater breached a major embankment in Bangladesh’s Sylhet region, affecting around two million people, swamping dozens of villages and killing at least 10.
Arifuzzman Bhuiyan, head of the state-run Flood Forecasting and Warning Center, said that the floods had hit some 70 percent of Sylhet district and about 60 percent of neighboring Sunamganj.
“It is one of the worst floods in the region,” he said.
But he said the situation would improve further in the next few days after heavy rains stopped.
Police said that a scuffle broke out in the rural town of Companyganj on Saturday as authorities stepped up relief operations for the roughly two million people hit.
“There were more flood-affected people than the estimated relief packs. At one point everyone started to snatch relief goods when police dispersed the crowd,” local police chief Sukanto Chakrobarti said.
Mozibur Rahman, head of Sylhet district, said that the embankment washed away along the Bangladesh-India border was yet to be repaired.
“It is impossible to fix the embankment unless waterflow from India plunges. The inundation scenario in Sylhet city has improved. But outer towns are still underwater,” Rahman said.
“We are trying to send relief and have opened hundreds of shelters for the flood-hit people.”
Mofizul Islam, a resident of Sylhet city where floodwaters were slowly subsiding, said that he fell off his motorbike after he hit a pothole hidden under the water on Sunday.
“It is very risky for the people who are going out today,” Islam said.
Over the border in India, around 50 people have been killed in days of flooding, landslides and thunderstorms, according to local disaster management authorities.
In the north-eastern state of Assam, authorities said on Sunday that the death toll from the floods had reached 18.
According to the Assam State Disaster Management Authority (ASDMA), almost 3,250 villages were partially or fully submerged.
ASDMA officials said the situation had improved slightly but that it remained critical in some districts.
According to their estimate, more than 92,000 people were in relief camps.
The state and national rescue forces, helped by the army, were working to rescue people from villages and distribute food, clean drinking water and other essentials, as well as to clear roads.
West of Assam, at least 33 people were killed in Bihar state in thunderstorms on Thursday.
Bihar, in common with other parts of northern India and Pakistan, has been suffering an intense heatwave, with temperatures reaching 40 degrees Celsius (104 degrees Fahrenheit).


Shanghai partly resumes public transport in patchy reopening

Shanghai partly resumes public transport in patchy reopening
Updated 22 May 2022

Shanghai partly resumes public transport in patchy reopening

Shanghai partly resumes public transport in patchy reopening
  • China’s largest city has been almost entirely locked down since April
  • Four of the city’s 20 subway lines restarted Sunday along with some road transport

SHANGHAI: Shanghai partially restarted public transport Sunday and set out new classifications for COVID-19 risk areas, signaling a gradual reopening after nearly two months sealed off from the outside world.
China’s largest city has been almost entirely locked down since April, when it became the epicenter of the country’s worst coronavirus outbreak since the early days of the pandemic.
Unlike other major economies, Beijing has dug in its heels on a strict zero COVID-19 approach that relies on stamping out clusters as they emerge, though this has become increasingly difficult with the infectious omicron variant.
But as new infections have slowed, Shanghai has cautiously eased restrictions, with some factories resuming operations and residents in lower-risk areas allowed to venture outdoors.
Four of the city’s 20 subway lines restarted Sunday along with some road transport, with officials announcing last week that it would provide a “basic network covering all central urban areas.”
Those who take public transport will have to show a negative COVID-19 test within 48 hours of their journey and have a “normal temperature,” they added Saturday.
Shanghai will also classify areas as high, medium or low-risk after May 31, city health official Zhao Dandan told a press briefing on Sunday.
Districts with 10 or more reported COVID-19 cases — or at least two community infections — will be considered “high-risk” while areas with no positive cases for 14 days will be deemed “low-risk,” Zhao said.
Medium or high-risk areas face lockdowns of two weeks.
The new system appears to set the stage for a degree of movement comparable to other cities, a shift from tough current measures in which even residents of lower risk areas have faced tight restrictions.
But despite broader attempts to ease those restrictions, the city’s central Jing’an district was back under lockdown on Sunday, according to an official notice.
Jing’an will undergo three consecutive rounds of mass COVID-19 testing from Sunday and residents are not to leave their homes during this period, a WeChat notice said.
“Exit permits that have been issued will be suspended,” the notice added Saturday, while assuring residents that “victory is not far away.”
The city of 25 million residents reported more than 600 COVID cases on Sunday, 570 of them asymptomatic, according to National Health Commission data.
But restrictions continued in other Chinese cities with COVID-19 cases, including the capital Beijing, which has already banned dining out and forced millions to work from home.
As of Saturday, nearly 5,000 people in Beijing’s Nanxinyuan residential compound had been relocated to quarantine hotels after 26 new infections were discovered in recent days, state media reported.
Fears have run high that the city may take a similar approach to Shanghai, where the lockdown has denied many adequate access to food and medical care.


Biden lands in Japan on second leg of Asia trip

Biden lands in Japan on second leg of Asia trip
Updated 22 May 2022

Biden lands in Japan on second leg of Asia trip

Biden lands in Japan on second leg of Asia trip
  • US president to meet with Japan’s prime minister and unveil a US-led trade initiative for the region on Monday

YOKOTA AIR BASE, Japan: President Joe Biden landed in Japan on Sunday for the second leg of a trip to reinforce US alliances in Asia.
Biden, making his first trip to Asia as president, arrived at Yokota Air Base outside Tokyo, and will meet with Japan’s prime minister and unveil a US-led trade initiative for the region on Monday, before joining a summit of the Quad regional grouping.


UK PM Johnson has not intervened in ‘partygate’ report, education minister says

UK PM Johnson has not intervened in ‘partygate’ report, education minister says
Updated 22 May 2022

UK PM Johnson has not intervened in ‘partygate’ report, education minister says

UK PM Johnson has not intervened in ‘partygate’ report, education minister says
  • The Labour Party has called on Johnson to explain why he met senior civil servant Sue Gray to discuss her final report into parties held at Downing Street

LONDON: British Prime Minister Boris Johnson has not intervened in an internal investigation into breaches of COVID-19 rules at his Downing Street office and residence, education minister Nadhim Zahawi said on Sunday.
Britain’s opposition Labour Party has called on Johnson to explain why he met senior civil servant Sue Gray to discuss publication of her final report into parties held at Johnson’s Downing Street office during COVID-19 lockdowns, which is expected next week.
“The Prime Minister has never intervened in the investigation that Sue Gray conducted,” Zahawi told Sky News, adding that he could not say who had called the meeting.
Johnson has faced widespread calls from opposition politicians and some in his own party for him to resign over the “partygate” scandal after it emerged that he and officials had broken stringent lockdown laws enacted by his government.